Physical rehabilitation offers a number of techniques that can help decrease pain and improve mobility in dogs with arthritis. It can broadly be divided into three categories:
- Manual therapy
- Therapeutic modalities
- Therapeutic exercise
Manual Therapy
Manual therapy is what human physical therapists do to relieve pain and improve joint motion for their patients. Veterinary rehabilitation therapists can also use joint mobilization, soft tissue mobilization/ massage, passive range of motion (PROM), and stretching to treat dogs with arthritis.
Animals with arthritis often develop compensatory dysfunctions in surrounding soft tissues and distant joints. Rehabilitation therapists (veterinarians or physical therapists trained in canine rehab) will want to assess your dog’s whole body to identify where they might have compensatory pain, trigger points, or reduced mobility.
Your rehabilitation therapist will want to apply manual therapy techniques to the arthritic joints as well as other areas of the body, where needed.
Therapeutic Modalities
A therapeutic modality means applying something physical to your dog’s body, often to help relieve pain. Veterinary rehabilitation therapists will often use:
- Cryotherapy (ice packs)
- Thermotherapy (heat packs)
- Lasers
- Pulsed electromagnetic field (PEMF)
- Neuromuscular electrical stimulation/ transcutaneous electrical nerve stimulation (TENS)
- Extracorporeal shockwave therapy (ESWT).
Ice packs/ cryotherapy:
Ice is recommended to decrease inflammation following an acute injury or “flare up.” Ice will decrease blood flow to the area and numb the joint to reduce pain.
Your dog might feel better after exercising if you ice their sore joint with an ice pack. The ice pack should ideally be held in place for 15-20 minutes. NEVER place an ice pack directly on the skin. Instead, make sure you wrap it in a damp towel or pillowcase. Using an Ace bandage for moderate compression can also help.
Never leave your dog unattended with an ice pack. While cold compression or ice packs have not been specifically studied for dogs with arthritis, it is a practical and cost-effective means of reducing inflammation and pain and can be done at home.
Heat packs:
Heat is recommended to reduce muscle spasms and provide a soothing sensation. Applying heat increases blood flow to an area, even if only slightly below the surface. If your dog has sore joints, ask your veterinarian about applying a warm pack to their low back or muscles surrounding the affected joint.
NOTE: **Heat should be applied at least 2 hours after exercise and should not be used in the acute stage of injury.
Therapeutic LASER/ photobiomodulation:
With laser therapy, light energy (photons) is applied to stimulate tissue. Therapeutic lasers stimulate cellular metabolism, fibroblast proliferation, collagen deposition and enhance angiogenesis, but they are not capable of cutting tissue.
Additionally, they can provide pain relief through increased secretion of serotonin, increased release of endogenous opiates, decreased inflammation and blockage of afferent C fiber depolarization. Several lasers are currently marketed for veterinary use and differ based on their wavelength and power, which influence the depth of penetration and time required for treatment, respectively, and their ability to cause injury to the eye and skin.
Talk to your veterinarian if laser therapy might help your dog.
PEMF:
All cells and tissues in the body have their own electromagnetic field. When cells are diseased or damaged, the electrical gradient across the cell membrane is disrupted, and the electromagnetic field in the body is altered.
Applying PEMF generators have been shown to increase certain molecules (such as Nitric Oxide) that help restore the normal electromagnetic field in the body. PEMF therapy is used to decrease pain and inflammation and stimulate tissue healing.
There are studies in human and veterinary patients documenting these effects, though the optimal protocol for use for dogs with arthritis is not yet known. PEMF is applied through a bed that your dog can lay on, such as the Respond PEMF bed, or through disposable devices that are placed or held over the treatment area, such as the Assisi Loop. They can both be purchased for home use.
TENS:
A continuous, low-level electrical current is applied to the body to stimulate a type of nerve ending that transmits sensations to the spinal cord faster than the dull ache associated with chronic pain.
That means that the spinal cord and brain recognize the “tingly” sensation of TENS rather than pain from arthritis. Talk to your veterinarian or rehabilitation therapist about TENS for your dog.
ESWT:
This uses high-powered focused ultrasound. Sound waves are transmitted to the tissue, which stimulates cells to express growth factors and other molecules that improve healing and decrease pain. One study found that dogs with unilateral hip arthritis who had ESWT treatment developed a more symmetrical gait after use.
Another study found that ESWT for elbow arthritis resulted in improved peak vertical force, similar to what is expected with NSAIDs. Of all of the modalities used in veterinary rehabilitation, ESWT currently has the most research in clinical veterinary patients.
Therapeutic Exercise
In addition to regular aerobic exercises such as walking or swimming, talk to your veterinarian or rehabilitation therapist about incorporating therapeutic exercises into your home routine to help increase or maintain your dog’s strength, flexibility, and proprioception. This helps your dog maintain their functional mobility.
Hydrotherapy
Water offers several beneficial properties that make hydrotherapy and the underwater treadmill (UWTM) useful in veterinary rehabilitation. Depending on the height of the water, the buoyancy of the water will provide varying levels of support for dogs that are weak or in pain.
The cohesion and turbulence of the water provide a resistant force when walking through the water. This helps increase the range of motion of their joints. Additionally, it is more challenging to walk through water, leading to increased muscle strength and endurance following regular therapy in an underwater treadmill.
Finally, the water temperature in most underwater treadmills or pools is kept around 85 degrees F, which helps increase blood flow to the limbs and provides a soothing environment. Studies have found that dogs enrolled in a UWTM-based rehabilitation program have improved weight loss and maintenance of muscle mass—both of which are crucially important to help manage arthritis!
Want to find a rehab professional near you? Visit www.rehabvets.org
References
Millis DL, Levine D, Taylor RA, eds: Canine rehabilitation and physical therapy. St. Louis, MO. Saunders; 2004.
Zink MC and Van Dyke JB, eds: Canine Sports Medicine and Rehabilitation. Ames, IA. Wiley-Blackwell; 2018
Millis DL, Levine D. The role of exercise and physical modalities in the treatment of osteoarthritis. Vet Clin North Am Small Anim Pract 27(4):913-930, 1997.
Knight KL, Draper DO: Therapeutic modalities: the art and science. Philadelphia, PA. Wolter Kluwer/Lippincott Williams and Wilkins; 2008.
Prentice WE: Therapeutic modalities: for sports medicine and athletic training. New York, NY. McGraw-Hill Higher Education; 2009.
Millis DL, Francis D, Adamson C: Emerging modalities in veterinary rehabilitation. Vet Clin Small Anim 35:1335-1355, 2005.
Barlas D, Homan CS, Thode HC: In vivo tissue temperature comparison of cryotherapy with and without external compression. Ann Emerg Med 28:436-439, 1996.
Bocobo C, Fast A, Kingery W, Kaplan M: The effect of ice on intra-articular temperature in the knee of the dog. Am J Phys Med Rehabil 70(4):181-185, 1991.
Deal DN, Tipton J, Rosencrance E, Curl WW, Smith TL: Ice reduces edema: A study of microvascular permeability in rats J Bone Joint Surg 84(9):1573-1578, 2002.
Rexing J, Dunning D, Siegel AM, Knap K, Werbe B: Effects of cold compression, bandaging, and microcurrent electrical therapy after cranial cruciate ligament repair in dogs. Vet Surg 39:54-58, 2010.
Drygas KA, McClure S, Goring RL, Pozzi A, Roberston SA, Wang C: Prospective evaluation of cold compression therapy on postoperative pain, swelling, range of motion and lameness following tibial plateau leveling osteotomy in dogs. J Am Vet Med Assoc 238(10):1284-1291, 2011.
Kieves, NR, Bergh MS, Zellner E, Wang C. Pilot study measuring the effects of bandaging and cold compression therapy following tibial plateau levelling osteotomy. J Small Anim Pract. 2016: 57(10): 543-547.
Rogatko CP, Baltzer WI, Tennant R. Preoperative low level laser therapy in dogs undergoing tibial plateau levelling osteotomy: A blinded, prospective, randomized clinical trial. VCOT 2017:30:46-53.
Tunér J, Hode L, Nobel A: The Laser Therapy Handbook. Grangesberg, Sweden. Prima Books AB; 2007.
Wong-Riley MT, Liang HL, Eells JT, et al: Photobiomodulation directly benefits primary neurons functionally inactivated by toxins: role of cytochrome c oxidase. J Biol Chem 2005;280: 4761-4771
Joensen J, Demmink JH, Johnson MI, et al: The thermal effects of therapeutic lasers with 810 and 904 nm wavelengths on human skin. Photomed Laser Surg 2011:29(3):145-153
Hashmi JT, Huang YY, Sharma SK, et al: Effect of pulsing in low-level light therapy. Lasers Surg Med 2010;42:450-466
Ilic S, Leichliter S, Streeter J, et al: Effects of power densities, continuous and pulse frequencies, and number of sessions of low-level laser therapy on intact rat brain. Photomed Laser Surg 2006;24(4):458-466
Bjordal JM, Couppe C, Ljunggren AE: Low level laser therapy for tendinopathy evidence of a dose-response pattern. Phys Therapy Rev 2001;6:91-99
Sakurai Y, Yamaguchi M, Abiko Y: Inhibitory effect of low-level laser irradiation on LPS-stimulated prostaglandin E2 production and cyclooxygenase-2 in human gingival fibroblasts. Eur J Oral Sci 2000;108: 29-34
Aimbiro F, Albertini R, Pacheco MT, et al: Low level laser therapy induces dose-dependent reductions of TNF-alpha levels in acute inflammation. Photomed Laser Surg 2006;24:33-37
Viegas VN, Abreu ME, Viezzer C, et al: Effect of low-level laser therapy on inflammatory reactions during wound healing: comparison with meloxicam. Photomed Laser Surg 2007;25: 467-473
Fulop AM, Dhimmer S, Deluca JR, et al: A meta-analysis of the efficacy of laser phototherapy on pain relief. Clin J Pain 2010;26:729-736
Bjordal JM, Couppe C, Chow RT, et al: A systematic review of low level laser therapy with location-specific doses for pain from chronic joint disorders. Aust J Physiotherapy 2003;49:107-116
Hegedus B, Viharos L, Gervain M, Galfi M: The effects of low-level laser in knee osteoarthritis: A double blind, randomized, placebo-controlled trial. Photomed Laser Surg 2009;27(4):577-584
Soriano F, Campana V, Moya M, et al: Photobiomodulation of pain and inflammation in microcrystalline arthropathies: experimental and clinical results. Photomed Laser Surg 2006;24(2):140-150
Looney AL, Huntingford JL, Blaeser LL, Mann S. A randomized blind placebo-controlled trial investigating the effects of photobiomodulation therapy on canine elbow osteoarthritis. Can Vet J 2018 59(9):959-966.
Scardino MS, Swaim SF, Sartin EA, et al. Evaluation of treatment with a pulsed electromagnetic field on wound healing, clinicopathologic variables, and central nervous system activity of dogs. Am J Vet Res. 59(9):1177-1181, 1998.
Alvarez LX, McCue J, Lam NK, et al. Effect of targeted pulsed electromagnetic field therapy on canine postoperative hemilaminectomy: A double-blind, randomized, placebo-controlled clinical trial. J Am Anim Hosp Assoc 2019; 55:83-91.
Johnson JM, Johnson AL, Pijanowski GJ: Rehabilitation of dogs with surgically treated cranial cruciate ligament deficient stifles by use of electrical stimulation of muscles. Am J Vet Res 58:1473-1478, 1997.
Sems A, Dimef R, Iannotti JP: Extracorporeal shock wave therapy in the treatment of chronic tendinopathies. J Am Acad Orthop Surg 14:195-204, 2006.
Laverty PH, McClure SR: Initial experience with extracorporeal shock wave therapy in six dogs—part 1. Vet Comp Orthop Traumatol 15: 177-183, 2002.
Dahlberg J, Fitch G, Evans RB, McClure SR, Conzemius M. The evaluation of extracorporeal shockwave therapy in naturally occurring osteoarthritis of the stifle joint in dogs. Vet Comp Orthop Traumatol 18(3): 147-52, 2005.
Mueller M, Bockstahler B, Skalicky M, Mlacnik E, Lorinson D: Effects of radial shockwave therapy on the limb function of dogs with hip osteoarthritis. Vet Rec 160(22): 762-5, 2007.
Gallagher A, Cross AR, Sepulveda G. The effect of shockwave therapy on patellar ligament desmitis after tibial plateau leveling osteotomy. Vet Surg 41(4):482-485, 2012.
Kieves NR, MacKay CS, Adducci K, et al. High energy focused shock wave therapy accelerates bone healing: A blinded, prospective, randomized canine clinical trial. VCOT. 2015:28:425-432.
Souza AN, Ferreira MP, Hagen SC, Patrício GC, Matera JM. Radial shock wave therapy in dogs with hip osteoarthritis. Vet Comp Orthop Traumatol. 2016;29(2):108-14. doi: 10.3415/VCOT-15-01-0017. Epub 2016 Jan 20.
Mueller M, Bockstahler B, Skalicky M, Mlacnik E, Lorinson D. Effects of radial shockwave therapy on the limb function of dogs with hip osteoarthritis.
Vet Rec. 2007 Jun 2;160(22):762-5.
Carr JG, Millis DL, Weng HY. Exercises in canine physical rehabilitation: range of motion of the forelimb during stair and ramp ascent. J Small Anim Pract 54(8):409-413, 2013.
Millard RP, Headrick JF, Millis DL. Kinematic analysis of the pelvic limbs of healthy dogs during stair and decline slope walking. J Small Anim Pract 51(8):419-422, 2010.
Bockstahler BA, Prickler B, Lewy E, et al. Hind limb kinematics during therapeutic exercises in dogs with osteoarthritis of the hip joints. 73(9):1371-1376, 2012.
Holler PJ, Brazda V, Dal-Bianco B, et al. Kinematic motion analysis of the joints of the forelimbs and hind limbs of dogs during walking exercise regimens. Am J Vet Res 71(7):734-740, 2010.
Marsolais GS, McLean S, Derrick T, Conzemius MG. Kinematic analysis of the hind limb during swimming and walking in healthy dogs and dogs with surgically corrected cranial cruciate ligament rupture. J Am Vet Med Assoc 222(6):739-743, 2003.
Durant AM, Millis DL, Headrick JF. Kinematics of stair ascent in healthy dogs. Vet Comp Orthop Traumatol 24(2):99-105, 2011.
Levine D, Marcellin-Little DJ, Millis DL, et al. Effects of partial immersion in water on vertical ground reaction forces and weight distribution in dogs. Am J Vet Res 71(12):1413-1416, 2010.
Piccione G, Casella S, Panzera M, et al: Effect of moderate treadmill exercise on some physiological parameters in untrained beagle dogs. Exp Anim 61(5):511-512, 2012.
Snigdha S, de Rivera C, Milgram NW, Cotman CW. Exercise enhances memory consolidation in the aging brain. Front Aging Neurosci 6(3):1-14, 2014.
Chauvet A, Laclair J, Elliott DA, German AJ. Incorporation of exercise, using an underwater treadmill, and active client education into a weight management program for obese dogs. 52(5):491-496, 2011.
Mlacnik E, Bockstahler BA, Muller M, et al. Effects of caloric restriction and moderate or intense physiotherapy program for treatment of lameness in overweight dogs with osteoarthritis. J Am Vet Med Assoc 2006; 229:1756-1760.
Marshall WG, Bockstahler BA, Hulse DA and Carmichael S. A review of osteoarthritis and obesity: current understanding of the relationship and benefit of obesity treatment and prevention in the dog. Vet Comp Orthop Trauamatol 2009;22:339-345.